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Wendlinger S, Wohlfarth J, Siedel C, Kreft S, Kilian T, Junker S, Schmid L, Sinnberg T, Dischinger U, Heppt MV, Wistuba-Hamprecht K, Meier F, Erpenbeck L, Neubert E, Goebeler M, Gesierich A, Schrama D, Kosnopfel C, Schilling B. Susceptibility of Melanoma Cells to Targeted Therapy Correlates with Protection by Blood Neutrophils. Cancers (Basel) 2024; 16:1767. [PMID: 38730718 PMCID: PMC11083732 DOI: 10.3390/cancers16091767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Elevated levels of peripheral blood and tumor tissue neutrophils are associated with poorer clinical response and therapy resistance in melanoma. The underlying mechanism and the role of neutrophils in targeted therapy is still not fully understood. Serum samples of patients with advanced melanoma were collected and neutrophil-associated serum markers were measured and correlated with response to targeted therapy. Blood neutrophils from healthy donors and patients with advanced melanoma were isolated, and their phenotypes, as well as their in vitro functions, were compared. In vitro functional tests were conducted through nonadherent cocultures with melanoma cells. Protection of melanoma cell lines by neutrophils was assessed under MAPK inhibition. Blood neutrophils from advanced melanoma patients exhibited lower CD16 expression compared to healthy donors. In vitro, both healthy-donor- and patient-derived neutrophils prevented melanoma cell apoptosis upon dual MAPK inhibition. The effect depended on cell-cell contact and melanoma cell susceptibility to treatment. Interference with protease activity of neutrophils prevented melanoma cell protection during treatment in cocultures. The negative correlation between neutrophils and melanoma outcomes seems to be linked to a protumoral function of neutrophils. In vitro, neutrophils exert a direct protective effect on melanoma cells during dual MAPK inhibition. This study further hints at a crucial role of neutrophil-related protease activity in protection.
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Affiliation(s)
- Simone Wendlinger
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
- Mildred Scheel Early Career Center Wuerzburg, University Hospital Wuerzburg, 97080 Würzburg, Germany
| | - Jonas Wohlfarth
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Claudia Siedel
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Sophia Kreft
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Teresa Kilian
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Sarah Junker
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Luisa Schmid
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Tobias Sinnberg
- Division of Dermatooncology, Department of Dermatology, University of Tübingen, 72076 Tübingen, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ulrich Dischinger
- Department of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Kilian Wistuba-Hamprecht
- Skin Cancer Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany
| | - Friedegund Meier
- Department of Dermatology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, 01307 Dresden, Germany
| | - Luise Erpenbeck
- Department of Dermatology, University of Münster, 48149 Münster, Germany
| | - Elsa Neubert
- Leiden Academic Centre for Drug Research, Leiden University, 2333 Leiden, The Netherlands
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen University, 37075 Göttingen, Germany
| | - Matthias Goebeler
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Anja Gesierich
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - David Schrama
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Corinna Kosnopfel
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
- Mildred Scheel Early Career Center Wuerzburg, University Hospital Wuerzburg, 97080 Würzburg, Germany
- Department of Hematology, Oncology and Pneumology, University Hospital Münster, 48149 Münster, Germany
| | - Bastian Schilling
- Department of Dermatology, University Hospital Würzburg, 97080 Würzburg, Germany
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Placke JM, Kimmig M, Griewank K, Herbst R, Terheyden P, Utikal J, Pföhler C, Ulrich J, Kreuter A, Mohr P, Gutzmer R, Meier F, Dippel E, Welzel J, Engel DR, Kreft S, Sucker A, Lodde G, Krefting F, Stoffels I, Klode J, Roesch A, Zimmer L, Livingstone E, Hadaschik E, Becker JC, Weichenthal M, Tasdogan A, Schadendorf D, Ugurel S. Correlation of tumor PD-L1 expression in different tissue types and outcome of PD-1-based immunotherapy in metastatic melanoma - analysis of the DeCOG prospective multicenter cohort study ADOREG/TRIM. EBioMedicine 2023; 96:104774. [PMID: 37660535 PMCID: PMC10483509 DOI: 10.1016/j.ebiom.2023.104774] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND PD-1-based immune checkpoint inhibition (ICI) is the major backbone of current melanoma therapy. Tumor PD-L1 expression represents one of few biomarkers predicting ICI therapy outcome. The objective of the present study was to systematically investigate whether the type of tumor tissue examined for PD-L1 expression has an impact on the correlation with ICI therapy outcome. METHODS Pre-treatment tumor tissue was collected within the prospective DeCOG cohort study ADOREG/TRIM (CA209-578; NCT05750511) between February 2014 and May 2020 from 448 consecutive patients who received PD-1-based ICI for non-resectable metastatic melanoma. The primary study endpoint was best overall response (BOR), secondary endpoints were progression-free (PFS) and overall survival (OS). All endpoints were correlated with tumor PD-L1 expression (quantified with clone 28-8; cutoff ≥5%) and stratified by tissue type. FINDINGS Tumor PD-L1 was determined in 95 primary tumors (PT; 36.8% positivity), 153 skin/subcutaneous (34.0% positivity), 115 lymph node (LN; 50.4% positivity), and 85 organ (40.8% positivity) metastases. Tumor PD-L1 correlated with BOR if determined in LN (OR = 0.319; 95% CI = 0.138-0.762; P = 0.010), but not in skin/subcutaneous metastases (OR = 0.656; 95% CI = 0.311-1.341; P = 0.26). PD-L1 positivity determined on LN metastases was associated with favorable survival (PFS, HR = 0.490; 95% CI = 0.310-0.775; P = 0.002; OS, HR = 0.519; 95% CI = 0.307-0.880; P = 0.014). PD-L1 positivity determined in PT (PFS, HR = 0.757; 95% CI = 0.467-1.226; P = 0.27; OS; HR = 0.528; 95% CI = 0.305-0.913; P = 0.032) was correlated with survival to a lesser extent. No relevant survival differences were detected by PD-L1 determined in skin/subcutaneous metastases (PFS, HR = 0.825; 95% CI = 0.555-1.226; P = 0.35; OS, HR = 1.083; 95% CI = 0.698-1.681; P = 0.72). INTERPRETATION For PD-1-based immunotherapy in melanoma, tumor PD-L1 determined in LN metastases was stronger correlated with therapy outcome than that assessed in PT or organ metastases. PD-L1 determined in skin/subcutaneous metastases showed no outcome correlation and therefore should be used with caution for clinical decision making. FUNDING Bristol-Myers Squibb (ADOREG/TRIM, NCT05750511); German Research Foundation (DFG; Clinician Scientist Program UMEA); Else Kröner-Fresenius-Stiftung (EKFS; Medical Scientist Academy UMESciA).
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Affiliation(s)
- Jan-Malte Placke
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Mona Kimmig
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Klaus Griewank
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | | | | | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany.
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar, Germany.
| | - Jens Ulrich
- Skin Cancer Center, Department of Dermatology, Harz Clinics, Quedlinburg, Germany.
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany.
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany.
| | - Ralf Gutzmer
- Department of Dermatology, Skin Cancer Center Minden, Minden, Germany.
| | - Friedegund Meier
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany.
| | - Julia Welzel
- Department of Dermatology, Augsburg Medical Center, Augsburg, Germany.
| | - Daniel Robert Engel
- Department of Immunodynamics, Institute for Experimental Immunology and Imaging, Medical Research Centre, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Sophia Kreft
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany.
| | - Antje Sucker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Frederik Krefting
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Ingo Stoffels
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Joachim Klode
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Alexander Roesch
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany.
| | - Jürgen C Becker
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; Translational Skin Cancer Research, West German Cancer Center, University Medicine Essen, Essen, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Michael Weichenthal
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany.
| | - Alpaslan Tasdogan
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Germany; German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany.
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Kuhn CK, Meister J, Kreft S, Stiller M, Puppel SH, Zaremba A, Scheffler B, Ullrich V, Schöneberg T, Schadendorf D, Horn S. TERT expression is associated with metastasis from thin primaries, exhausted CD4+ T cells in melanoma and with DNA repair across cancer entities. PLoS One 2023; 18:e0281487. [PMID: 37418389 PMCID: PMC10328343 DOI: 10.1371/journal.pone.0281487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations occur frequently in cancer, have been associated with increased TERT expression and cell proliferation, and could potentially influence therapeutic regimens for melanoma. As the role of TERT expression in malignant melanoma and the non-canonical functions of TERT remain understudied, we aimed to extend the current knowledge on the impact of TERT promoter mutations and expression alterations in tumor progression by analyzing several highly annotated melanoma cohorts. Using multivariate models, we found no consistent association for TERT promoter mutations or TERT expression with the survival rate in melanoma cohorts under immune checkpoint inhibition. However, the presence of CD4+ T cells increased with TERT expression and correlated with the expression of exhaustion markers. While the frequency of promoter mutations did not change with Breslow thickness, TERT expression was increased in metastases arising from thinner primaries. As single-cell RNA-sequencing (RNA-seq) showed that TERT expression was associated with genes involved in cell migration and dynamics of the extracellular matrix, this suggests a role of TERT during invasion and metastasis. Co-regulated genes found in several bulk tumors and single-cell RNA-seq cohorts also indicated non-canonical functions of TERT related to mitochondrial DNA stability and nuclear DNA repair. This pattern was also evident in glioblastoma and across other entities. Hence, our study adds to the role of TERT expression in cancer metastasis and potentially also immune resistance.
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Affiliation(s)
- Christina Katharina Kuhn
- Rudolf Schönheimer Institute of Biochemistry, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Jaroslawna Meister
- Rudolf Schönheimer Institute of Biochemistry, University of Leipzig, Medical Faculty, Leipzig, Germany
- Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sophia Kreft
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, and German Cancer Consortium Partner Site Essen/Düsseldorf, Essen, Germany
| | - Mathias Stiller
- Institute of Pathology, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven-Holger Puppel
- Rudolf Schönheimer Institute of Biochemistry, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, and German Cancer Consortium Partner Site Essen/Düsseldorf, Essen, Germany
| | - Björn Scheffler
- DKFZ-Division Translational Neurooncology at the West German Cancer Center, University Hospital Essen/University of Duisburg-Essen, Essen, Germany
| | - Vivien Ullrich
- DKFZ-Division Translational Neurooncology at the West German Cancer Center, University Hospital Essen/University of Duisburg-Essen, Essen, Germany
| | - Torsten Schöneberg
- Rudolf Schönheimer Institute of Biochemistry, University of Leipzig, Medical Faculty, Leipzig, Germany
- School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, and German Cancer Consortium Partner Site Essen/Düsseldorf, Essen, Germany
| | - Susanne Horn
- Rudolf Schönheimer Institute of Biochemistry, University of Leipzig, Medical Faculty, Leipzig, Germany
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, and German Cancer Consortium Partner Site Essen/Düsseldorf, Essen, Germany
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Zaremba A, Mohr P, Gutzmer R, Meier F, Pföhler C, Weichenthal M, Terheyden P, Forschner A, Leiter U, Ulrich J, Utikal J, Welzel J, Kaatz M, Gebhardt C, Herbst R, Sindrilaru A, Dippel E, Sachse M, Meiss F, Heinzerling L, Haferkamp S, Weishaupt C, Löffler H, Kreft S, Griewank K, Livingstone E, Schadendorf D, Ugurel S, Zimmer L. Immune checkpoint inhibition in patients with NRAS mutated and NRAS wild type melanoma: a multicenter Dermatologic Cooperative Oncology Group study on 637 patients from the prospective skin cancer registry ADOREG. Eur J Cancer 2023; 188:140-151. [PMID: 37245442 DOI: 10.1016/j.ejca.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Melanomas frequently harbour somatic mutations in BRAF (40%) or NRAS (20%). Impact of NRAS mutations on the therapeutic outcome of immune checkpoint inhibitors (ICI) remains controversial. Potential correlation of the NRAS mutational status and programmed cell death ligand-1 (PD-L1) expression in melanoma is unknown. PATIENTS AND METHODS Advanced, non-resectable melanoma patients with known NRAS mutation status treated with first-line ICI between 06/2014 and 05/2020 in the prospective multicenter skin cancer registry ADOREG were included. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) according to NRAS status were analysed. A multivariate Cox model was used to analyse factors associated with PFS and OS; survival was analysed using the Kaplan-Meier approach. RESULTS Among 637 BRAF wild-type patients, 310 (49%) had an NRAS mutation with Q61R (41%) and Q61K (32%). NRAS-mutated (NRASmut) melanomas were significantly more often located on the lower extremities and trunk (p = 0.001); nodular melanoma was the most common subtype (p < 0.0001). No significant differences were found for PFS and OS for anti-PD1 monotherapy (2-year PFS 39%, [95% confidence interval (CI), 33-47] in NRASmut patients and 41% [95% CI, 35-48] in NRAS-wild type (NRASwt) patients; 2-year OS was 54% [95% CI, 48-61] in NRASmut patients and 57% [95% CI, 50-64] in NRASwt patients) and anti-PD1 plus anti-CTLA4 therapy between both cohorts (2-year PFS was 54% [95% CI, 44-66] in NRASmut patients and 53% [95% CI, 41-67] in NRASwt patients; 2-year OS was 58% [95% CI, 49-70] in NRASmut patients and 62% [95% CI, 51-75] in NRASwt patients). The ORR to anti-PD1 was 35% for NRASwt patients and 26% for NRASmut patients and 34% compared to 32% for combinational therapy. Data on PD-L1 expression was available in 82 patients (13%). PD-L1 expression (>5%) was not correlated to NRAS mutational status. In multivariate analysis, elevated lactate dehydrogenase, Eastern Cooperative Oncology Group performance status ≥ 1, and brain metastases were significantly associated with a higher risk of death in all patients. CONCLUSIONS The PFS and OS were not affected by NRAS mutational status in patients treated with anti-PD1-based ICI. Similar ORR was seen in NRASwt and NRASmut patients. Tumour PD-L1 expression did not correlate with NRAS mutational status.
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Affiliation(s)
- Anne Zaremba
- Department of Dermatology, University Hospital Essen, Essen, Germany.
| | - Peter Mohr
- Department of Dermatology, Elbe Clinic Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Hannover Medical School, Skin Cancer Centre Hannover, Hannover, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany; Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany; National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Claudia Pföhler
- Saarland University Medical Center, Department of Dermatology, Homburg, Saarland, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | - Andrea Forschner
- Division of Dermatooncology, Department of Dermatology, University Medical Center, Tuebingen, Germany
| | - Ulrike Leiter
- Division of Dermatooncology, Department of Dermatology, University Medical Center, Tuebingen, Germany
| | - Jens Ulrich
- Department of Dermatology, Harz Clinic Quedlinburg, Quedlinburg, Germany
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, Gera, Germany
| | - Christoffer Gebhardt
- Department of Dermatology, University Hospital Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rudolf Herbst
- Department of Dermatology, Helios Klinikum Erfurt GmbH, Erfurt, Germany
| | - Anca Sindrilaru
- Department of Dermatology, University Hospital Ulm, Ulm, Germany
| | - Edgar Dippel
- Department of Dermatology, Clinic of the City of Ludwigshafen on the Rhine gGmbH, Ludwigshafen am Rhein, Germany
| | - Michael Sachse
- Department of Dermatology, Bremerhaven Reinkenheide Hospital gGmbH, Bremerhaven, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Munich, Munich, Germany; Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Sophia Kreft
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Klaus Griewank
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Dresden, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen, Essen, Germany; German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Dresden, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
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5
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Kreft S, Glutsch V, Zaremba A, Schummer P, Mohr P, Grimmelmann I, Gutzmer R, Meier F, Pföhler C, Sachse MM, Meiss F, Forschner A, Haferkamp S, Welzel J, Terheyden P, Herbst R, Utikal J, Kaatz M, Weishaupt C, Kreuter A, Debus D, Duecker P, Sindrilaru A, Löffler H, Schley G, Weichenthal M, Schadendorf D, Ugurel S, Gesierich A, Schilling B. MAPKinase inhibition after failure of immune checkpoint blockade in patients with advanced melanoma - An evaluation of the multicenter prospective skin cancer registry ADOREG. Eur J Cancer 2022; 167:32-41. [PMID: 35366571 DOI: 10.1016/j.ejca.2022.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Forty to sixty percent of patients with advanced melanoma show primary resistance to PD-1-based immunotherapy, 30-40% of initial responders also progress. Here, we evaluated the outcome of second-line targeted therapy (TT) after progression on PD-1-based immune checkpoint inhibition (ICI) in BRAFV600-mutated melanoma. In addition, we report data on the activity of re-exposure with PD-1-based regimes. METHODS Patients with advanced (non-resectable stage III or IV, AJCC 2017, 8th edition) melanoma progressing on PD-1-based ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line BRAF plus MEK inhibition were identified from the prospective multicenter skin cancer registry ADOREG. RESULTS We identified 108 patients with unresectable stage III or stage IV melanoma progressing on first-line ICI (nivolumab, pembrolizumab or ipilimumab plus nivolumab) and receiving second-line combined BRAF/MEK inhibition. Seventy-three percent of the cohort presented with primary PD-1 resistant disease. Median progression-free survival (PFS) on ICI was 2.6 (95% CI 2.2-2.9) months. Median PFS on subsequent TT was 6.6 (95% CI 5.4-7.8) months. Median OS from start of second-line TT was 16.0 (95% CI 11.2-20.8) months. The 3-year PFS and OS rates on second-line TT were 16% and 30%. The objective response rate (ORR) and disease control rate (DCR) to TT were 42.6% and 55.6%. In patients with brain metastases, the ORR and DCR were 31.4% and 43.1%. Patients without brain metastases showed an ORR and DCR of 52.6% and 66.7%, respectively. Response to first-line ICI was associated with a numerically higher ORR and DCR to second-line TT and improved OS on TT. Twenty-three patients received third-line ICI of whom two patients showed an objective response. CONCLUSIONS BRAF plus MEK inhibition shows meaningful activity and outcome in patients with advanced melanoma resistant to anti-PD-1-based immunotherapy. Rates of long-term benefit and survival in our study were similar to those reported for treatment-naïve patients receiving first-line MAPKi.
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Affiliation(s)
- Sophia Kreft
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Valerie Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Anne Zaremba
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Patrick Schummer
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Imke Grimmelmann
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany; Department of Dermatology, Mühlenkreiskliniken, Johannes Wesling Medical Center, Ruhr-University, Minden, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany; Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Claudia Pföhler
- Saarland University Medical School, Department of Dermatology, Homburg/Saar, Germany
| | - Michael Max Sachse
- Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Forschner
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Patrick Terheyden
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Rudolf Herbst
- Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Jochen Utikal
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Martin Kaatz
- Department of Dermatology, Wald-Klinikum Gera, Gera, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - Dirk Debus
- Department of Dermatology, Paracelsus Medical University Nuremberg, Nuremberg General Hospital, Nuremberg, Germany
| | - Pia Duecker
- Department of Dermatology, Hospital Dortmund, Dortmund, Germany
| | - Anca Sindrilaru
- Department of Dermatology, University Hospital of Ulm, Ulm, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Gaston Schley
- Department of Dermatology, Helios Klinikum Schwerin, Schwerin, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, University Hospital Essen & German Cancer Consortium (DKTK), Partner Site Essen, Germany
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
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Stojanov S, Ravnikar M, Berlec A, Kreft S. Interaction between silver fir ( Abies alba) wood water extract and lactobacilli. Pharmazie 2021; 76:614-617. [PMID: 34986959 DOI: 10.1691/ph.2021.1794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Water extract from silver fir (Abies alba) wood represents a rich source of lignans and other phenols that are effective in different pathological conditions, such as diabetes, cardiovascular diseases and psoriasis. Its interaction with the gastrointestinal environment is crucial when the extract is orally administered. In this study we tested the in-vitro interaction between water extract of silver fir wood and ten different Lactobacillus species that are found in the gastrointestinal tract, vagina or are used in food industry. We tested both ways of interaction: 1) the bacterial influence on the chemical composition of the extract and 2) influence of the extract on the bacterial growth. We demonstrated that the extract is compatible with all of the bacteria and does not impair their growth. Furthermore the extract acted as a prebiotic for some bacteria including: L. paracasei, L. acidophilus, L. rhamnosus, L. gasseri, L. crispatus and L. bulgaricus, suggesting that the compounds in the extract can stimulate their growth. However, the ten lactobacilli did not show any chemical changes in lignan metabolism and the production of enterodiol and enterolactone, which are considered the final metabolic products of lignans and are produced by different gut bacteria. This study indicates that the silver fir wood extract is nutritious for some Lactobacillus bacteria and can be used as a prebiotic.
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Affiliation(s)
- S Stojanov
- Department of Biotechnology, Jožef Stefan Institute, University of Ljubljana, Slovenia; Faculty of Pharmacy, University of Ljubljana, Slovenia;,
| | - M Ravnikar
- Faculty of Pharmacy, University of Ljubljana, Slovenia
| | - A Berlec
- Department of Biotechnology, Jožef Stefan Institute, University of Ljubljana, Slovenia; Faculty of Pharmacy, University of Ljubljana, Slovenia
| | - S Kreft
- Faculty of Pharmacy, University of Ljubljana, Slovenia
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7
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Storey L, Abdul-Latif M, Kreft S, Barrett E, Pickering LM, Rohaan MW, Ahmed S, Eigentler TK, Hassel JC, Haferkamp S, Meiss F, Steeb T, Shaw HM, Blank CU, Van Akkooi ACJ, Larkin JMG, Schilling B, Lorigan P, Nathan PD. Checkpoint inhibitor treatment in patients with isolated in-transit melanoma metastases. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10070 Background: In the context of multiple in-transit melanoma metastases without nodal involvement, a variety of treatment modalities have historically been employed including surgery, laser, isolated limb perfusion/infusion, intralesional interleukin-2, T-VEC and electrochemotherapy. Unfortunately, most patients treated with these modalities experience subsequent disease progression. While checkpoint inhibitors (CPI) are a standard of care for bulky unresectable stage III and for stage IV melanoma, patients with isolated in-transit metastases were rarely included in registration studies. There are anecdotal reports of lower response rates in these patients despite them having disease characteristics that would usually be associated with a good response. Methods: We report data from 11 retrospective patient cohorts treated at cancer centres across Europe who received CPI between 2016 and April 2019. All patients had multiple in-transit metastases without clinical or radiological evidence of nodal or distant disease. Disease response was assessed using CT, PET-CT or MRI depending on clinical indication. All patients had at least one prior resection of loco-regional relapsed disease and were deemed not curable by further surgery. Results: Sixty three patients meeting criteria were identified, 40 females and 23 males. Median age was 72 years and 54 (86%) patients had a normal lactate dehydrogenase (LDH). 19 (30%) patients had a BRAF mutation. At treatment initiation, the majority 55 (87.3%) received single agent PD-1 inhibitor, 7 (11.1%) combination ipilimumab + nivolumab and 1 (1.6%) received single agent anti-CTLA 4. The overall response rate was 62% for the full population. The response rate with anti-PD1 monotherapy was 59%. With a median FU of 23 months, the median PFS was 26 months, median OS not reached. OS estimates with 95% CI: 12 month - 93% (87-100%), 24 month - 88% (80-98%), 36 month - 80% (67-95%). Conclusions: The results show a high response rate to CPI in patients with in-transit metastases and support early treatment with CPI following identification of in-transit metastases not curable with surgery whilst disease characteristics remain favourable.
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Affiliation(s)
- Lucy Storey
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Sophia Kreft
- Department of Dermatology, University Hospital Würzburg, Germany, Germany
| | - Emma Barrett
- Manchester Foundation Trust, Education and Research Centre, Wythenshawe Hospital, Manchester, United Kingdom
| | | | - Maartje W. Rohaan
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Sobia Ahmed
- University of Manchester, Manchester, United Kingdom
| | - Thomas K. Eigentler
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen, Germany
| | - Jessica Cecile Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Frank Meiss
- Deparment of Dermatology and Venereology, University of Freiburg, Freiburg, Germany
| | - Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Heather May Shaw
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Paul Lorigan
- University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
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8
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Kreft S, Gesierich A, Eigentler T, Franklin C, Valpione S, Ugurel S, Utikal J, Haferkamp S, Blank C, Larkin J, Garbe C, Schadendorf D, Lorigan P, Schilling B. Efficacy of PD-1-based immunotherapy after radiologic progression on targeted therapy in stage IV melanoma. Eur J Cancer 2019; 116:207-215. [PMID: 31212163 DOI: 10.1016/j.ejca.2019.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Targeted therapy (TT) is an effective treatment for advanced BRAFV600-mutated melanoma, but most patients eventually acquire resistance and progress. Here, we evaluated the outcome of second-line immune checkpoint blockade (ICB) after progression on dual BRAF and MEK inhibition. METHODS Patients with metastatic melanoma progressing on combined BRAF + MEK inhibition and receiving second-line ICB between 2015 and 2019 in 9 tertiary referral centres were enrolled. Demographic and clinical data and blood counts of all patients were collected retrospectively. RESULTS We identified 99 patients with stage IV melanoma receiving ICB (nivolumab, pembrolizumab [n = 39] or ipilimumab plus nivolumab [n = 60]) after progression on combined TT. The median progression-free survival was similar in the PD-1 and ipilimumab plus nivolumab group (2.6 months [95% confidence interval {CI}, 2.0-3.1] vs. 2.0 [95% CI, 1.4-2.6], p = 0.15). The objective response rate was 18.0% in the PD-1 and 15.0% in the ipilimumab plus nivolumab group (p = 0.70). The disease control rate was 25.7% for monotherapy and 18.3% for combined ICB (p = 0.39). The median overall survival was 8.4 months (95% CI, 5.1-11.7) for patients receiving PD-1 monotherapy and 7.2 months (95% CI, 5.2-9.1) for patients receiving ipilimumab plus nivolumab (p = 0.86). The latter was associated with a higher rate of treatment-related adverse events (AEs). No significant association of laboratory values or clinicopathological characteristics with response to second-line ICB was observed. CONCLUSIONS PD-1 monotherapy and combined ipilimumab plus nivolumab show similar activity and outcome in patients with melanoma resistant to BRAF + MEK inhibition. However, combined ipilimumab plus nivolumab was associated with a higher rate of treatment-related AEs compared with monotherapy.
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Affiliation(s)
- Sophia Kreft
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Eigentler
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Cindy Franklin
- Department of Dermatology, University Hospital Cologne, Cologne, Germany
| | - Sara Valpione
- University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | - Selma Ugurel
- Department of Dermatology, University Hospital, Essen, Germany; German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen Utikal
- Department of Dermatology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Christian Blank
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - James Larkin
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Claus Garbe
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital, Essen, Germany; German Cancer Consortium of Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paul Lorigan
- University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany.
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Debeljak J, Ferk P, Čokolič M, Zavratnik A, Tavč Benković E, Kreft S, Štrukelj B. Randomised, double blind, cross-over, placebo and active controlled human pharmacodynamic study on the influence of silver fir wood extract (Belinal) on post-prandial glycemic response. Pharmazie 2018; 71:566-569. [PMID: 29441923 DOI: 10.1691/ph.2016.6658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
The aim of this study was to test the extract from silver fir wood (Belinal) on the reduction of the blood glucose concentrations after consumption of a standard meal. 31 healthy participants consumed 100 g of white bread 4 times (with 1 week washout period, consequently) concomitantly with a capsule of Belinal, capsule of chestnut wood extract, placebo or acarbose (active control). Glucose and insulin in the blood were measured before and after the meal. The area under the curve of glucose concentration in blood after the meal was 35 % lower when Belinal was added compared with the placebo group (p = 0.019). Acarbose lowered the area for 43 % (p = 0.002). By this, we proved that the effect of Belinal might be beneficial for prevention of diabetes. This is the first study that provides a scientific rationale for use of silver fir wood extract as food supplement for reduction of health risks connected to type 2 diabetes mellitus.
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Zorko MS, Štrukelj B, Švajger U, Kreft S, Lunder T. Efficacy of a polyphenolic extract from silver fir ( Abies alba) bark on psoriasis: a randomised, double-blind, placebo-controlled trial. Pharmazie 2018; 73:56-60. [PMID: 29441952 DOI: 10.1691/ph.2018.7741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Silver fir (Abies alba) bark extract contains a mixture of bioactive polyphenols. We tested their effectiveness in the treatment of psoriasis in order to further investigate the potential topical anti-inflammatory activity of polyphenols by means of a randomized, double-blind, placebo-controlled add-on clinical trial, after having examined their ability to downregulate the expression of IL-1β cytokine in monocyte/macrophage primary cell culture. 61 patients with mild psoriasis met the inclusion criteria and were willing to comply with protocol requirements, were enrolled in the study. The severity of the disease was measured by psoriasis area severity index (PASI). Treatment efficacy was evaluated by assessing erythema (E, 0 to 4-point scale), desquamation (D, 0 to 4-point scale) and induration (I, 0 to 4-point scale) of lesions before and after the treatment. All patients enrolled in the study had symmetrical psoriasis plaques on the skin. All patients received O/V ointment with 2% of silver fir bark extract and/or placebo, respectively. We compared medications by right/left intra-patient comparison, so that the control group was always contralateral of the tested one. Location of the tested or control site was randomised, using a computer-generated randomisation schedule. Silver fir extract was well-tolerated. A superiority of active treatment above placebo, based on the clinical investigational PASI score system was observed by 15 % in all volunteers and in 40% regarding the improvement of psoriasis on elbows. However, statistical analysis showed no significant differences between placebo and active treatment with the extract from silver fir bark (p < 0.05).
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11
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Kočevar Glavač N, Kreft S, Lunder M. Antimicrobial efficacy of selected natural preservatives in a cosmetic emulsion. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- N Kočevar Glavač
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - S Kreft
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - M Lunder
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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12
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Beović B, Kreft S, Seme K, Čižman M. The Impact of Total Control of Antibiotic Prescribing by Infectious Disease Specialist on Antibiotic Consumption and Cost. J Chemother 2013; 21:46-51. [DOI: 10.1179/joc.2009.21.1.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
We investigated the effect of ertapenem on carbapenem susceptibility of Pseudomonas aeruginosa. Antibiotic consumption was recorded monthly in defined daily doses (DDD)/100 patient-days in the infectious diseases (ID), abdominal surgery (AS), and surgical intensive care units (SICU) of a teaching hospital from January 2005 to December 2008. Trends of decreased susceptibility of P. aeruginosa were observed in all three units. After the introduction of ertapenem, the number of P. aeruginosa isolates/ 1000 patients-days per month increased in AS and in SICU (p=0.05). The increase in carbapenem non-susceptible isolates/1000 patients-days in the same units was less significant (p=0.07 and p=0.054). Correlations between ertapenem and the carbapenem non-susceptibility for the lagtime of 1 to 6 months ahead gave no significant result. In the SICU, 30% of variability of carbapenem non-susceptibility could be predicted by the consumption of ertapenem. There is no evidence that ertapenem alters the P. aeruginosa susceptibility to carbapenems, but the relationship deserves further observation.
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Affiliation(s)
- B Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
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14
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Beovic B, Kreft S, Seme K, Cizman M. The Role of Infectious Disease Specialist (ID) in Antibiotic Policy in Hospital. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Beović B, Kreft S, Osredkar J, Kese D, Bonac-Tuma B. Serum procalcitonin levels in patients with mild community-acquired pneumonia. Clin Microbiol Infect 2006; 11:1050-1. [PMID: 16307566 DOI: 10.1111/j.1469-0691.2005.01285.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Interference with fat hydrolysis results in the reduced use of ingested lipids. Inhibition of pancreatic lipase reduces the efficiency of fat absorption in the small intestine and thereby initiates modest long-term reduction in body weight. In an attempt to select peptides with affinity for the surface of pancreatic lipase and potential inhibitory activity, a random, cyclic heptapeptide phage-displayed library was used. Five independent selections, differing in elution step, were performed. In three selection protocols, a sequential elution strategy was applied in anticipation of improving the selection of high-affinity clones. Four heptapeptides with the highest affinity, seemingly for pancreatic lipase, were selected, synthesized, and characterized for their capacity to inhibit enzyme function. Although no clear consensus among the sequenced peptides was found, one of the selected peptides inhibited pancreatic lipase with an apparent inhibition constant of 16 muM.
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Affiliation(s)
- M Lunder
- Department of Pharmaceutical Biology, Faculty of Pharmacy, Ljubljana, Slovenia.
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17
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Beović B, Bonac B, Kese D, Avsic-Zupanc T, Kreft S, Lesnicar G, Gorisek-Rebersek J, Rezar L, Letonja S. Aetiology and Clinical Presentation of Mild Community-Acquired Bacterial Pneumonia. Eur J Clin Microbiol Infect Dis 2003; 22:584-91. [PMID: 13680399 DOI: 10.1007/s10096-003-0997-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, and antibody testing for Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in paired serum samples. One hundred thirteen patients were evaluable for clinical presentation and 109 for aetiological diagnosis. At least one pathogen was detected in 62.4% patients. The most common causative agents were Mycoplasma pneumoniae in 24.8%, Chlamydia pneumoniae in 21.1%, and Streptococcus pneumoniae in 13.8% of patients. Dual infection was detected in 8.3% of patients. Most patients suffered from cough, fatigue, and fever. Patients with atypical aetiology of pneumonia differed from those with typical bacterial pneumonia or pneumonia of unknown aetiology in age, presence of dyspnea, and bronchial breathing on lung auscultation. Patients with pneumococcal, chlamydial, and mycoplasmal infections differed in age, risk class, presence of dyspnea, bronchial breathing, and proteinuria. There was an overlap of other clinical symptoms, underlying conditions, and laboratory and radiographic findings among the groups of patients classified by aetiology. Since patients with mild community-acquired pneumonia exhibit similar clinical characteristics and, moreover, since a substantial proportion of cases are attributable to atypical bacteria, broad-spectrum antibiotic treatment seems to be recommended.
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Affiliation(s)
- B Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
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18
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Javernik S, Kreft S, Strukelj B, Vrecer F. Oxidation of lovastatin in the solid state and its stabilization with natural antioxidants. Pharmazie 2001; 56:738-40. [PMID: 11593996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Oxidative instability of the hydroxy methylglutaryl Co-A reductase inhibitor lovastatin in the solid state and stabilization with natural antioxidants (ascorbic acid, rutin, gallic acid, quercetin and caffeic acid) was investigated. Lovastatin in the solid state and binary mixtures with 10% (w/w), 25% (n/n), 12.5% (n/n) and 6.3% (n/n) of each of the antioxidants were prepared. Oxidation experiments were performed on the scanning calorimeter using dynamic oxygen atmosphere. The amount of non-oxidized lovastatin was determined using HPLC. The results of the experiments have shown that lovastatin is unstable to oxidation under higher temperatures and in the presence of oxygen, and that some antioxidants markedly stabilize the drug. The most significant antioxidative effect was seen with caffeic acid and rutin, followed by gallic acid and quercetin. Ascorbic acid was only moderately effective. The results prove that flavonoids do have significant antioxidative potential. This phenomenon can be used to improve oxidative stability of drugs such as lovastatin which are sensitive to the presence of oxygen.
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Affiliation(s)
- S Javernik
- Research & Development Division, Krka d.d., Novo mesto, Slovenia.
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Abstract
A capillary zone electrophoretic (CZE) method for the determination of usnic acid is described for the first time. Usnic acid is an antibiotic substance from lichens. Due to its low solubility in water, a high content of methanol in CZE buffer is required. Because of the methanol in the buffer, the electroosmotic flow velocity was lower than the electrophoretic mobility of usnic acid. Accordingly, the use of reversed-polarity (with the anode on the detector side of the capillary) was necessary. The optimal buffer composition was 50 mM NaOH, 20 mM acetic acid and 5% water in methanol. The detection limit of UV detector at 290 nm for usnic acid in the injected extract was 3.5 mg/L and the relative standard deviation of the normalized peak area was 3.3% at 250 mg/L.
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Affiliation(s)
- S Kreft
- Pharmacy, Ljubljana, Slovenia.
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20
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Abstract
Thrombin is the key serine proteinase of the coagulation cascade and therefore a suitable target for inhibition of blood coagulation. A number of pharmacologically active secondary metabolites from mushrooms have already been isolated, thus providing the rationale for screening for new thrombin inhibitors in mushrooms. In this study, inhibitory activities of mushroom extracts on thrombin and trypsin were measured using the chromogenic substrates H-D-phenylalanine-L-pipecolyl-L-arginine-paranitroaniline dihydrochloride (S-2238) for thrombin and N-benzoyl-D,L-Arg-p-nitroanilide (BAPNA) for trypsin. The inhibitory activities of extracts from 95 Basidiomycete species have been determined. The majority of samples inhibited trypsin and thrombin with various potencies; however, some extracts showed no activity against one or both of the enzymes. An aqueous extract of Gleophyllum odoratum exhibited high inhibitory activity on both thrombin and trypsin (72 and 60%, respectively), while extracts of Clitocybe gibba, Amanita virosa, Cantharellus lutescens, Suillus tridentinus, Hypoloma fasciculare and Lactarius badiosanguineus considerably inhibited thrombin (49, 48, 36, 34, 32 and 31%, respectively) and showed no inhibitory activity on trypsin. The results at this point are promising for further research with the objective of finding an effective and safe thrombin inhibitor.
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Affiliation(s)
- B Doljak
- Department of Phrmaceutical Biology, Faculty of Pharmacy, University of Ljubljana, Slovenia.
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21
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Zajc Kreft K, Kreft S, Komel R, Grubic Z. Nonradioactive northern blotting for the determination of acetylcholinesterase mRNA. Comparison to the radioactive technique. Pflugers Arch 2000; 439:R66-7. [PMID: 10653146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
A sensitive nonradioactive northern blotting for the detection of acetylcholinesterase mRNA in mammalian tissues is described and compared to its radioactive version. Best results were obtained if digoxigenin labeled RNA probe was used for hybridization and CDP-Star, a chemiluminescent alkaline phosphatase substrate, for detection. The described nonradioactive technique for acetylcholinesterase mRNA determination is as sensitive as the radioactive one, but requires no protection against radiation and is less time consuming. Because of higher stability of the labeled probe, nonradioactive technique is also more convenient from the standpoint of experimental planning.
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Affiliation(s)
- K Zajc Kreft
- Institute of Pathophysiology, School of Medicine, Ljubljana, Slovenia
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Mlinaric A, Kreft S, Umek A, Strukelj B. Screening of selected plant extracts for in vitro inhibitory activity on HIV-1 reverse transcriptase (HIV-1 RT). Pharmazie 2000; 55:75-7. [PMID: 10683878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Methanolic-aqueous extracts of 70 plants were investigated for their ability to inhibit HIV-1 reverse transcriptase activity in vitro. Two thirds of the extracts screened showed more than 50% inhibition. Two extracts inhibited the enzyme completely while four exhibited more than 90% inhibition. Tannins as nonspecific HIV-1 RT inhibitors were detected and removed from the extracts. The IC50 values of the most potent extracts after the removal of tannins for the HIV-1 RT inhibition are as follows: Sambucus racemosa 0.017 mg/ml and Geranium phaeum 0.067 mg/ml. Daunomycine was chosen as a standard substance in the non-radioactive immuno assay used for screening. As a result from the future isolation and characterization of these compounds, new leading structures are expectable.
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Affiliation(s)
- A Mlinaric
- Department of Pharmaceutical Biology, Faculty of Pharmacy, University of Ljubljana, Slovenia
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Kreft S, Knapp M, Kreft I. Extraction of rutin from buckwheat (Fagopyrum esculentumMoench) seeds and determination by capillary electrophoresis. J Agric Food Chem 1999; 47:4649-4652. [PMID: 10552865 DOI: 10.1021/jf990186p] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The content of the flavonoid rutin was determined in different milling fractions of buckwheat seeds and in buckwheat stems, leaves, and flowers. The extraction was performed by using a solvent containing 60% of ethanol and 5% of ammonia in water. The extracts were analyzed by capillary electrophoresis (running buffer of 50 mM borate (pH 9.3), 100 mM sodium dodecyl sulfate; determination at 380 nm). In bran fractions the concentration of rutin was 131-476 ppm, and in flour fractions 19-168 ppm. On average, about 300, 1000, and 46000 ppm of rutin were found in leaves, stems, and flowers, respectively. The results indicate that buckwheat could be an important nutritional source of flavonoids, especially in countries with a low mean daily flavonoid intake.
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Affiliation(s)
- S Kreft
- Faculty of Pharmacy and Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1111 Ljubljana, Slovenia
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Abstract
The 74 samples of six HYPERICUM species (H. PERFOROTUM, H. HIRSUTUM, H. MACULATUM, H. TETRAPTERUM, H. MONTANUM, AND H. HUMIFUSUM) were collected around Slovenia and analysed for the content of ten substances (rutin, hyperoside, isoquercetin, quercitrin, quercetin, I3,II8-biapigenin, amentoflavone, pseudohypericin, hypericin, and hyperforin). The flowers were analysed separately from the green parts of the plants (herbs). The highest content of most of the substances was found in the flowers of H. PERFOROTUM. Among the herbal samples (without flowers), H. MONTANUM and H. HIRSUTUM contained significantly higher levels of amentoflavone (average 3-fold and 2.5-fold higher, respectively), than the herbs of H. PERFOROTUM. In the herbal part of H. PERFOROTUM the contents of all constituents strongly correlate with the contents of the same compound in flowers, except for the content of amentoflavone, which is independent in these two parts. Rutin and hyperoside are in positive correlation, and quercitrin is in negative correlation with the altitude of the growing site.
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Affiliation(s)
- A Umek
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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Brank M, Zajc-Kreft K, Kreft S, Komel R, Grubic Z. Biogenesis of acetylcholinesterase is impaired, although its mRNA level remains normal, in the glucocorticoid-treated rat skeletal muscle. Eur J Biochem 1998; 251:374-81. [PMID: 9492307 DOI: 10.1046/j.1432-1327.1998.2510374.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acetylcholinesterase (AChE) is responsible for the hydrolysis of acetylcholine in the neuromuscular junction and other cholinergic synapses. Insight into the mechanisms controlling AChE expression in skeletal muscle is important for understanding formation, plasticity, and various dysfunctions of the neuromuscular junction. We have investigated the mechanisms responsible for the decreased AChE activity in the fast rat sternomastoideus muscle after chronic glucocorticoid treatment. Under such conditions fast skeletal muscles become atrophic and loose 30-40% of their AChE activity. In order to establish at which level synthesis of AChE is affected by glucocorticoids, we studied the effects of chronic dexamethasone treatment at both AChE mRNA and mature enzyme levels. Reduced rate of AChE recovery after subtotal irreversible AChE inhibition was observed during the first week of dexamethasone treatment, but not later. Statistical analyses of four independent northern blots revealed unchanged AChE mRNA levels. At the same time, we observed more than 60% decrease in the (G1+G2)/A12 ratio of molecular forms at the expense of G forms. It has been generally accepted that globular G1 and G2 molecular forms are synthesized in the rough endoplasmic reticulum as precursors of asymmetric (A) AChE forms, assembled in the Golgi apparatus. Reduced levels of G1 and G2 AChE forms, in combination with unchanged AChE mRNA, are therefore consistent with the reports demonstrating that glucocorticoids downregulate muscle protein synthesis at the translational level. Our findings support but not entirely prove the concept that impaired translation and/or posttranslational control are the primary cause of decreased AChE activity in the glucocorticoid-treated muscle.
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Affiliation(s)
- M Brank
- Institute of Pathophysiology, School of Medicine, University of Ljubljana, Slovenia
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Kreft S, Ravnikar M, Mesko P, Pungercar J, Umek A, Kregar I, Strukelj B. Jasmonic acid inducible aspartic proteinase inhibitors from potato. Phytochemistry 1997; 44:1001-1006. [PMID: 9055446 DOI: 10.1016/s0031-9422(96)00668-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A new cDNA clone coding for an aspartic proteinase inhibitor homologue was isolated from a potato tuber cDNA library. Southern blot analysis was used to study the structural diversity of the aspartic proteinase inhibitor gene family in several species of the Solanaceae. The existence of sequence-homologous genes was confirmed in the genomic DNA of different potato cultivars (Solanum tuberosum L. cv. Désirée, Pentland Squire and Igor), tomato (Lycopersicon esculentum Mill.), aubergine (S. melongena L.) and a wild type of bittersweet (S. dulcamara L.). Northern blot hybridization of total RNA, isolated from leaves under non-stress conditions, of different solanaceous species and of potato tubers showed that the gene transcripts encoding aspartic proteinase inhibitors occur mainly in potato tubers. The presence of several cathepsin D inhibitor isoforms has been detected at the protein level. At least four isoforms were isolated by affinity chromatography on cathepsin D-Sepharose and characterized. Additionally, exogenous treatment of potato plantlets by jasmonic acid (JA) over a wide range of concentrations (0-100 microM) was performed in a stem node culture in vitro. We demonstrated that the expression of aspartic proteinase inhibitor mRNA was drastically induced in potato shoots at concentrations of 50-100 microM JA.
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Affiliation(s)
- S Kreft
- Faculty of Pharmacy, Ljubljana, Slovenia
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Kreft S, Zajc-Kreft K, Zivin M, Sket D, Grubic Z. Application of the nonradioactive in situ hybridization for the localization of acetylcholinesterase mRNA in the central nervous system of the rat; comparison to the radioactive technique. Pflugers Arch 1996; 431:R309-10. [PMID: 8739388 DOI: 10.1007/bf02346392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this preliminary report nonradioactive digoxigenine-based and radioactive in situ hybridization procedures for the localization of acetylcholinesterase mRNA were tested and compared in rat brain. General patterns of Ache mRNA localization observed by both techniques did not differ significantly and were practically the same as reported in previous in situ studies on the mammalian brain. Shorter procedure time and avoidance of precautions necessary at work with radioactive materials are major advantages of nonradioactive technique. Under- and over- staining can be prevented by direct examination of coloring reaction. Faint staining in the control experiment with heterologous DNA suggests that proper stringency is essential for the specificity of staining.
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Affiliation(s)
- S Kreft
- Institute of Pathophysiology, School of Medicine, Ljubljana, Slovenia
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